The effects of vitamin D supplementation on proatherogenic inflammatory markers and carotid intima media thickness in subjects with metabolic syndrome: a randomized double-blind placebo-controlled clinical trial.

PURPOSE: Metabolic syndrome may predispose to cardiovascular diseases. Since, in recent studies, vitamin D is advocated for cardioprotective roles, this study was designed to investigate the effects of vitamin D supplementation on proatherogenic inflammatory markers and common carotid intima media thickness in subjects with metabolic syndrome. METHODS: This randomized double blind clinical trial was conducted in Tabriz, Iran. Eligible subjects (n = 80) with metabolic syndrome were recruited thorough advertisement and randomized to receive either vitamin D (50,000 IU/week) or matching placebo for 16 weeks. Interlukin-6, high sensitivity C-reactive protein, vascular cell adhesion molecule-1, E-selectin, and common carotid intima media thickness were measured at the beginning and end of the study. The study was registered at http://www.irct.ir (code: IRCT201409033140N14). RESULTS: Sixteen weeks supplementation with vitamin D increased median of serum 25-hydroxy vitamin D [25(OH)D] and mean calcium levels (p < 0.001) in the intervention group. There was also a significant difference in parathyroid hormone level at the end of the study (p < 0.001). Vitamin D treatment reduced IL-6 level after 16 weeks (p = 0.027). Compared to baseline, vascular cell adhesion molecule-1 and E-selectin levels decreased significantly in vitamin D treated subjects; however, there were no significant differences between two groups. No effect of vitamin D supplementation was observed in either common carotid intima media thickness or high sensitivity C-reactive protein concentrations at the end of the study (p > 0.05). CONCLUSIONS: Vitamin D supplementation improved some proatherogenic inflammatory markers in subjects with metabolic syndrome. No changes of high sensitivity C-reactive protein and carotid intima media thickness were shown after 16 weeks.

Emergency ligation of external iliac artery for control of bleeding following allograft nephrectomy.

Renal transplantation is the best treatment for end-stage renal disease. Vascular complications of renal transplantation can be hazardous. Bleeding from the anastomotic site in external iliac artery is a nightmare for kidney transplant surgeons. Ligation of the external iliac artery might possibly lead to the loss of the lower limbs. We present two cases of postallograft nephrectomy bleeding, in which the external iliac artery was ligated without consequent ischemia.

Ultrasonographic evaluation of bowel wall thickness and intramural blood flow in ulcerative colitis.

Aim. This study aimed at assessing Doppler ultrasonographic findings of gut wall vessels and thickness in active and quiescent ulcerative colitis. Methods. Fifty patients with ulcerative colitis were studied using transabdominal grayscale and Doppler sonography of sigmoid, distal and middle parts of descending colon in different stages of the disease. Thickness of colon wall in the most involved site, number of color signals in each box, resistive index (RI), and pulsatility index (PI) were evaluated. Results. The median thickness of the colon wall in the most involved sites was 4.3 mm in acute phase and 4.4 mm in the inactive phase (P = 0.47). The median number of the color signals in the active phase at the most involved site, distal part of descending colon and sigmoid was higher than that of the color signals in the inactive phase (P = 0.0001). In the most involved site, the PI and RI were undetectable in the inactive phase. The median PI was 1.4 in the mild phase, 1.3 in the moderate phase, and 1.1 in the severe phase (P = 0.002). Conclusion. In contrast to the colon wall thickness, increased intramural blood flow reflected the clinical severity in ulcerative colitis patients.

Prevalence of significant carotid artery stenosis in Iranian patients with peripheral arterial disease.

BACKGROUND: Generalized screening for carotid artery stenosis with carotid duplex ultrasonography in patients with peripheral arterial disease is controversial. OBJECTIVES: The aim of the present study was to determine the prevalence of significant internal carotid artery (ICA) stenosis in a group of Iranian patients with peripheral arterial disease. METHODS: We prospectively screened 120 patients with a known diagnosis of peripheral vascular disease for carotid artery stenosis. Based on the angiographic assessment of abdominal aorta and arteries of the lower extremities, patients with stenosis greater than 70% in the lower extremity arteries were included. A group of healthy individuals aged ≥ 50 years was recruited as a control. Risk factors for atherosclerosis including smoking, diabetes mellitus, hyperlipidemia, ischemic heart disease, and cerebrovascular disease were recorded. Common carotid arteries (CCAs) and the origins of the internal and external arteries were scanned with B-mode ultrasonography. Significant ICA stenosis, > 70% ICA stenosis but less than near occlusion of the ICA, was diagnosed when the ICA/CCA peak systolic velocity ratio was ≥ 3.5. RESULTS: Ninety-five patients, with a mean age of 58.52 ± 11.04 years, were studied. Twenty-five patients had a history of smoking, six patients had a history of coronary artery disease, six patients had hypertension, and ten patients had diabetes mellitus. Significant ICA stenosis was present in four patients (4.2%) with peripheral arterial disease in one healthy individual (1%) of the control group (P > 0.05). In terms of the risk factors for atherosclerosis, no statistically significant relationship was found between individual atherosclerotic risk factors and significant ICA stenosis (P > 0.05). CONCLUSION: The prevalence of significant ICA stenosis in Iranian patients with peripheral arterial disease is low. In addition, there is no relationship between individual atherosclerotic risk factors and significant ICA stenosis.

Are Doppler ultrasonography parameters symmetric between the right and left kidney?

BACKGROUND: Among numerous modalities applied for evaluation of kidney diseases, Doppler ultrasonography (DU) provides information about the hemodynamic status of the kidneys. Meanwhile, the variability in DU parameters of the right and left kidney is a matter of controversy. The aim of this study was to determine whether any difference exists between the DU indices of the right and left kidney. METHODS: Retrospectively, we collected DU findings of 25 healthy potential renal transplant donors. All donors underwent renal DU and multidetector computed tomographic angiography before donor nephrectomy. DU indices, including peak systolic volume (PSV), resistive index (RI), pulsatility index (PI), end-diastolic volume (EDV), and acceleration time (AT), were recorded. RESULTS: The median age of the donors was 27 (range 23-39) years. The median PSV, RI, EDV, and AT for the right kidney were 29 cm/sec, 0.59, 10.9 cm/sec, and 50 msec, respectively. For the left kidney, the median PSV, RI, EDV, and AT were, respectively, 26.8 cm/sec, 0.60, 10.6 cm/sec, and 43 msec. Among the DU indices, median PI of the right kidney was significantly different from that of the left kidney (1.02 versus 0.95, P = 0.01). CONCLUSION: In conclusion, the present study revealed that right kidney DU indices, except for PI, may not differ from those of the left kidney.

Comparison of normal values of Duplex indices of vertebral arteries in young and elderly adults.

BACKGROUND: Considering the role of aging in brain atrophy and cerebral vascular demand, we carried out this study to clarify the role of aging in duplex indices of vertebral arteries. METHODS: From June 2005 to June 2006, 96 volunteers with age range of 20 to 95 years, were evaluated with color doppler for duplex indices of vertebral arteries. Sever hemodynamic stenosis was excluded in all of these patients. These volunteers were subdivided in two groups: younger and older than 60 year old. In all of these patients we measured diameter, peak systolic velocity (PSV), resistive index (RI), and flow volume (FV) of vertebral arteries in right and left sides. RESULTS: There was no significant difference in diameter, PSV, RI and FV between two groups. We have clarified that in patients younger than 60 year old, comparing right and left vertebral arteries, PSV and FV were higher in left side. CONCLUSION: Duplex indices of vertebral arteries are age independent in adults.

Combined aneurysms of the main renal and celiac arteries: an unusual association.

Celiac artery aneurysm (CAA) is a rare condition, which occasionally occurs in association with such visceral aneurysms as splenic, common hepatic, left hepatic, superior mesenteric and renal arteries. We describe our observation of a patient with CAA and bilateral main renal artery aneurysm. To the best of our knowledge, a combination of these visceral arterial aneurysms has not been reported previously. The available literature on this topic is briefly reviewed.